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FY15 SRC Access Agreement SBI Criminal HistoryPAT NICCRORY GOVERNOR NORTH CAROLINA STATE BUREAU OF INVESTIGATION DEPARTMENT OF PUBLIC SAFETY 3320 GARNER ROAD P.O. BOX 29500 RALEIGH, NC 27626 -MOO (919) 662-4500 FAX: (419) 0624523 91, B. W. COLLIER ACTING DIRECTOR INFORMATION ACCESS AGREEMENT FOR STATE ONLY CRIMINAL HISTOR"V' 114-19.3 In order to gain access to obtain criminal history record checks through the State Bureau of Investigation (SBI), the following six (6) items must be submitted: 1. Proof that your agency qualifies under N.C.G.S. 114 -19.3. We would need written documentation, or other acceptable proof that your agency qualifies and under which part of the statute. This can include, but is not limited to, articles of incorporation, any pamphlets that you might have, and a letter explaining what your agency does. 2. A letter from the Administrator of the agency stating who will be responsible for the billing invoice. This should be on agency letterhead which includes agency name, address, telephone number and fax number. 3. The name(s) of the individual(s) who will be designated as an authorized official to submit and /or receive criminal history record information from the SBI. 4, Regulations Regarding Receipt of Criminal History Information form signed by ALL personnel designated in above letter as an authorized official to submit and /or receive criminal history record information from the SBI. (You may make copies of this form) 5. Access Agreement read and signed and dated by the Administrator and notarized on the fourth page at the BOTTOM only. "Please return pages 1-4 of the completed access agreement with all supporting documentation listed above. We will mail you a copy of the approved access agreement. 6. Federal Tax Identification Number (EIN) for billing purposes. If you should have any questions, please feel free to contact me at (919) 662 -4509 ext 6366. Sincerely, Cindy Coats Applicant Unit Supervisor Criminal Information and Identification Section Enclosure(s) 2222 South College Road Wilmington, NC 28403 Telephone 910-798-6400 Fax 9.10-798-6411 111111II111111M f mlW December 4, 2014 Cindy Coates North Carolina State Bureau of Investigation 3320 Garner Road P.O. Box 29500 Raleigh, NC 27626-0500 Dear Ms. Coates: New Hanover County Foster Grandparent Program is in the process of applying to obtain criminal history checks through the North Carolina State Bureau of Investigation for our Foster Grandparent volunteers. Foster Grandparent volunteers are 55 years of age and older living on limited income and commit to volunteering in New Hanover public schools working with children helping them to read, assist children to develop skills, confidence, and strength to succeed in life. The Foster Grandparents volunteer 15 to 40 hours per week and receive a tax-free stipend of $2.65 per hour for their service. This program is part of the Corporation for National and Community Service (CNCS). The corporation requires all Foster Grandparents to obtain a criminal history check through the North Carolina State Bureau of Investigation. The Foster Grandparent Program qualifies under N.C. G. S. 114-19.3 (a) (10) "any organization or corporation, whether for profit or nonprofit, that provides direct care or services to children, the sick, the disabled, or the elderly." I have enclosed a Foster Grandparent pamphlet for your records. Please let me know if y on should need further information. Sincerely, Tracy A. Ash New Hanover County Foster Grandparent Program Manager Avril M. Pinder New Hanover County, Assistant County Manager GSJ 14-19.3 llagc I of I § 114-19.3. Criminal r-ecord c1mcks of providers of treatment for or services; to children, the elderly, niental health patients, the sick, and lite disabled. (it) Authority. --- The Department ot'Justice may provide to any of the following entities it criminal record check of an individual Nvho is eniploycd by that entity, has applied for employment with that entity, or has volunteered to provide direct care on behalf ofthat entity: (1) Hospitals licensed under Chapter 13 IE of the General Statwes, (2), (3) Repealed by Session Laws 2000-154, s. 5. effective JarIMUN' 1, 21101 . (4) Flospice"s licensed under Chapter 131F. of the General Statutes. (5) Child placin Q agencies licensed under Chapter 13 1 D o Fthe t. ienerla I Statutes (6) Residential child care facilities licensed under Chapter 13 11) (it' the Gencral Statutes. (7) 1 Tospitals licensed under Chapter 1220 of the General Statutes. (8) Repealed by Session Laws 21)0() -15 4, s, 5, el-fiective January 1, 2001 (9) Licensed child care facilities and nonlicensed child care homes reQuIated by the State. b. (10) Any, other organization or corporation. wlicther for profit or nonp•ollil. that provides direct care or services to children. (Ile sick, the disabled, Or (110 elderly- (b) Procedure, - A criminal record check may be Conducted by using an Individual's fing.erprint or any InIbrination required by the Department ot'Justice to identify that individual. A criminal record check shall be provided only if the individual whose record is checked consents to the record check. The information shall be kept confidential by the entity that receives the information. Upon the disclosure of'confidential infonnation under this section by the entity, the Department may refuse to provide further criminal record checks to that entity. (c) Repeated by Session Laws 1995 (Regular Session. 1996), c. 606, s. 1. (d) Foster or Adoptive Parent. — The Department Of' JUStiCC, A the request of at child placing agency lICCIISCd under Chapter 131 D of the General StatUteS or it local department of social services. may provide as criminal record check of as proSpeCLi�C foster care or adoptive parent if the prospective parent consents to the record check. The information shall be kept confidential and upon the disclosure of confidential inibrMatiOn Under this scc6on by the agency or department, the Departiricnt may refuse to provide rurther criminal record chccks tea that agency or department, (C) Fee. ­ The Departnient may charge it Ice to offset the cost incurred by it to conduct as criminal record check under this section "I"he (i_~e nmy not exceed 16MUCII dollars (S14.00). (1993. c, 403, s. 1; 1995, c. 453, s. 1; 1995 (Rep. Sess.. 1996), c. 606. s, 1, 19971-506 s. 38: '000 -15=4, s. 5,, 2003 -21x4, ;. ](2).) 1 W/G_ 10/6 2009 New Hanover County Senior Resource Center 2222 South College Road tl� Wilminp-ton, NC 28403 eph -798-6411 Telone 910�79&6400 Fax 910 a1171711. 1 December 4, 2014 Cindy Coates North Carolina State Bureau of Investigation 3320 Garner Road P,O. Box 29500 Raleigh, NC 27626-0500 Dear Ms. Coats: This letter is in reference to New Hanover County Senior Resource Center gaining access to obtain criminal history checks through the State Bureau of Investigation, Tracy A. Ash, New Hanover County Foster Grandparent Program Manager, will be ensuring proper processing ofthe billing invoice, Ms. Ash's address, phone number and fax number are listed above. If you should need further information feel free to contact Tracy Ash at 910-798-6407. Sincerely, Avril M. binder New Hanover County Assistant County Manager PAT MCCRORV GOVERNOR NORTH CAROLINA STATE BUREAU OF INVESTIGATION DEPARTMENT OF PUBLIC SAFETY 3320 GA RNER ROAD Po. BOX 29W R-AI,FIGH, NC 2762&-MGO (919) 662-4500 FAX: (919) 6624523 STATE BUREAU OF INVESTIGATION SPECIAL OPERATIONS DIVISION NON-CRI�MINAL JUSTICE ACCESS AGREEMENI MIUM91120M This agreement made and entered into by and between the State Bureau of Investigation, Special Operations Divi ion, Criminal Information and Identification Section (hereafter referred to as n t "CIIS") and Hf'AaQU_(1L1 I_Xun (hereafter referred to as "AGENCY") for the purpose and consideration hereafter set out.- M= The purpose of this Agreement is to outline the responsibilities of the AGENCY in regards to the receipt of North Carolina Criminal History Record Information (CHRI) from CIIS Section and the proper use and dissemination of that data by authorized personnel of the AGENCY. am A. CIIS agrees to provide the appropriate training to the AGENCY as requested or needed for the above mentioned CIIS system access. B. CIIS agrees to notify the AGENCY of any changes in the record disseminated to tM AGENCY, due to a court ordered expungement, which are discovered by Cll�) within ninety (90) days of dissemination of such record to the AGENCY. C. CIIS will notify the AGENCY six (6) months in advance of any change in the cost of providing CHRI. D. CIIS may conduct a compliance audit of the AGENCY in regards to the handling and dissemination of CHRI at any time. CIIS will give written notice sixty (60) days in advance of any audit. CIIS will conduct at least one (1) audit every three (3) year cycle, W Ill. Responsibilities of the AGENCY: The AGENCY agrees to comply with the following policies and procedures: A, The AGENCY hereby represents that the purpose for which it is authorized to receive CHRI on individuals who are currently employed, have applied for employment or to volunteer is to assist it in determining whether these individuals have a criminal record which would disqualify them from employment or volunteer services, Such access is allowed pursuant to N.C.G.S. 114-19.3. B. The AGENCY further agrees that its use of CHRI is for the above stated purpose alone and for no other, and that neither it, nor any of its employees, shall make any other or further use of such information, C. The AGENCY must make requests in writing through the Authorized Official to the CIIS, and such requests from other AGENCY Officials will not be honored. The applicant's/employee's complete name, sex, race, date of birth, social security number (optional) and any other descriptive data as shall be appropriate to identify the individual, shall be submitted either on the Authority for Release of Information form or the fingerprint card provided by the CIIS Section. The AGENCY understands that it will not submit the Authority for Release of Information form to CIIS with each set of fingerprints. However, the Authority for Release of Information form shall be retained by the AGENCY for a minimum period of one (1) year from the date the fingerprints are submitted to the CIIS. D. The AGENCY understands that under no circumstances shall CHRI obtained from CIIS be released to or reviewed by anyone other than the AGENCY and its authorized officials and may only be used for purposes authorized under N.C.G.S. 114-M3, E. The AGENCY shall be responsible for the security and privacy of the CHRI it receives, The CHRI shall be kept under lock and key, separate from the Personnel Files. The CHRI shall only be available to the authorized officials as set forth in this access agreement, F. The AGENCY shall be responsible for reviewing its laws and knowing what data can and cannot be used as grounds in denying or terminating employment in accordance with standards in the appropriate enabling legislation referred to above. G. Prior to denial or termination of employment based upon CHRI received from the CIIS, the AGENCY shall verify the existence of a record by either obtaining a certified public record or by submitting a fingerprint card of the individual to the CIIS for verification that the CHRI record belongs to the individual. -2- H. The AGENCY understands a "No Record" response on a name check does not necessarily mean that the individual does not have a criminal record, since an individual's record may be listed under another name or a different spelling of the name provided by the AGENCY, The submission of individual's fingerprint card is the only means by which CIIS can accurately match the individual to this criminal record on file with CIIS. The AGENCY understands that the procedure utilized under this agreement involves only a state criminal record search, and does not include a search of criminal records maintained by other states or the federal government. Also, the AGENCY understands that CIIS maintains only those records for which an individual is required by law to submit to the fingerprinting process; therefore, there are criminal records maintained by local agencies that are not on file with CIIS. The AGENCY agrees to pay the fee of ten dollars (10.00) for each name check or fourteen dollars (14.00) for every fingerprint card processed by CIIS, which reflects the cost of providing the CHRI record. The AGENCY understands it will be billed at the end of each month for the amount due. The AGENCY will return a copy of the invoice with the AGENCY's check in the amount of the total payment due. The payment is due the following month. The AGENCY's check should be made payable to the North Carolina State Bureau of Investigation and mailed to: NC State Bureau of Investigation Attention: Business Office PO Box 29500 Raleigh, North Carolina 27626-0500 If the information in the CHRI record is used to disqualify an individual, the official making the determination of suitability for employment shall provide the individual the opportunity to provide additional information, or challenge the accuracy of the information contained in the CHRI record. The official may disclose information contained in the CHRI check that is relevant to the disqualification, but may not provide a copy of the CHRI check to the applicant. The individual must be afforded a reasonable time to correct or complete this information. An individual should not be presumed to be guilty of any chargelarrest for which there is no final disposition stated on the CHRI record. Any individual wishing to correct, complete or otherwise challenge a CHRI record must avail themselves of the procedures set forth in the Division of Criminal Information (DCI) administrative procedures, (12NCAC 04F .0404) IV: Penalties/Liability: The CIIS Section reserves the right to terminate this Agreement upon determining that the AGENCY has violated any applicable law, rule or regulation or has violated the terms of this Agreement. Recipient Agency agrees to indemnify and to absolve of liability the North Carolina Department of Public Safety, SBI and its officials and employees from and against any and all claims, demands, actions, suits, and proceedings by others, against all liability including but not limited to any liability for damages by reason or arising out of any false arrest or imprisonment, employee action, or any action whatsoever, or against any lost, cost, expense, and damage, resulting therefrom, arising out of this Agreement, or breach of this Agreement, or CIIS rules and regulations, or involving use of information received from CIIS Recipient Agency, -3- This Agreement becomes effective on (Month/Day) By: Date: Signature of Authorized Official and Title Criminal Information and Identification Section Wake County, North Carolina Fa I certify that the following person personally appeared before me this N.: to me that he or she signed the foregoing document: 50 (AGENCY should complete required fields below) I certify that I have read and understand the terms of this Agreement with the North Carolina State Bureau of investigation, Criminal Information and Identification Section, and I will uphold ti Agreement, 1- 0 County, North Carolina '7709 I certify that the following person(s) personally appeared, before M thi� dax, each acknowledging to me that he or she signed the foregoing document: A, I Nrk� i- Date: t a�s I I q 0 4 R. Z! ot I/lItI". (Official Signature of Notary Public) AGENCY —State Only Revised Sept 201 0 J (Notary's Typed or Printed Name) My Commission Expires loll 9"1 Regulations Regarding Receipt of Criminal History Record Informatior North Carolina State Bureau of Investigation 1 Criminal history record information (CHR|) received from the NCS8i and the FBI (if applicable) must bo kept locked and secured, |t should only be available to the contact persons listed at the NCSBL 2. CHRI received by the agency should not be given to another agency or the applicant. 3. If the applicant should need tn challenge his/her record, they should contact the State Bureau nf Investigation Applicant Unit for a Right KnReview. 4. CHR| should only be used for the original hire/not hiredeoisimm, CHR| can change orbe updated atany time and, therefore, should not ba held for any other use. 5, The Authority for Release of Information form or the Electronic Form should be maintained for one year. 6� To dispose ofthe CHRI and the fingerprint card, either shred the information or burn it. It is not acceptable to discard theCHR| in the trash can. A|no, the agency should not have an outside agency do the shredding (called outsourcing). The agency must handle the shredding or burning of the documents in-house, then the agency can outoounoe the shredded items, 7. Bent prmcdne — Mhe NCGB| recommends that anyone with a felony conviction not have access to the CHRL B. If CHRI is received with an arrest that does not have a final court disposition, the clerk of court im the county the person was arrested mug be contacted to mbbsim the disposition before denying employment. If the agency does not understand the meaning nfa charge ora disposition, contact the clerk of court inthe arresting county for adefinition. A. Best practice - the NCSB| recommends doing e background check on all personnel that will be handling the CHR|. If the North Carolina General Statute for the agency does not allow a background check, a public record check through the Administrative Office oY the Courts can beconducted. 10 Do not ask a law enforcement agency to conduct name checks for the agency, There must be an approved local ordinance in place for this process. 11 When filling out the fingerprint card, follow the sample provided by the NCSB|, 12. Please keep a copy of the access agreement on file for audit purposes. Also, keep the original of the applicant's Authority for Release of Information form or Electronic Release form on file for one year. 11 Dn NOT give a copy of the Authority for Release ofInformation form to another agency. 14� Invoices will be mailed the first day cf each month. 15. Tu order fingerprint cards, fax a request to91Q-GG2-430O. 18. For questions, please contact: a. Applicant Unit Supervisor contact A18-SG2-45G9extG3GG b. For invoice questions (paymentm) contact 91946O2-45D8ex±8245 C. NCSBI fax numbers are 91Q-662-4380orB1S-66l-5B77 17 NCSB| mailing address is: Gtmb* Bureau of Investigation, Criminal Information and Identification Section, Attention: Applicant Un|t, P() Box 29500, Ro|eigh, WC 27626. 18. Please ensure all contact personnel sign a copy cf this form and include it im the packet mailed tnthe NCS8| Photocopies of this form may ba made gnneeded. °This form should be signed 8y all personnel who will receivelviewthe CHRI, (Recommend no more than three for security purpose^) This form may be photocopied�^ Revised Oct 2008 Regulations Regarding Receipt of Criminal History Record informatic-To North Carolina State Bureau of Investigation I � i Criminal history record information (CHRI) received from the NCSBI and the FBI (if applicable) must be kept locked and secured. It should only be available Nm the contact persons listed sk the NC8Bi 2. CHR|reoeived by the agency should not be given to another agency or the applicant. 3. (f the applicant should need to challenge hhs/her record, they should contact the State Bureau of Investigation Applicant Unit for m Right &nReview, 4. CHR) should only be used for the original hire/not hire decision. C0R| can change orbe updated atany time and, therefore, should not bm held for any other use. 5. The Authority for Release ofInformation form or the Electronic Form should be maintained for one year. 6, To dispose of the CHR| and the fingerprint card, either shred the information or burn it, It is not acceptable to discard the CHRI in the trash can. Also, the agency should not have an outside agency dm the shredding (called outsourcing). The agency must handle the shredding or burning of the documents in-house, then the agency can oubsourom the shredded items. 7. Best practice —theNCSB|rnoommendmthmtanymnem/ithehm|onyoomvichomnot_haveaoomxetotheCHR|. 8. |fCHR||s received with an arrest that does not have a final court disposition, the clerk nf court in the county the person was arrested must be contacted to obtain the disposition before denying employment. }fthe agency does not understand the meaning of a charge or a disposition, contact the clerk of court in the arresting county for adefinition. Q. Best practice -the NCSBI recommends doing a background check on all personnel that will be handling the CHR|. If the North Carolina General Statute for the agency does not allow a background check, apublic record check through the Administrative Office of the Courts can be conducted. % Dg not ask e law enforcement agency to conduct name checks for the agency. There must boanapproved local ordinance in place for this process, 11 When filling out the fingerprint card, follow the sample provided by the NCSB|. 12. Please keep a copy of the access agreement on file for audit purposes. Also, keep the original cfthe applicant's Authority for Release of Information form orElectronic Release form on file for one year. 13 Do NOT give a copy of the Authority for Release of Information form to another agency, 14, Invoices will be mailed the first day of each month, 15. To order fingerprint cards, fax a request to91A-662'438Q. 18. For questions, please contact: a. Applicant Unit Supervisor contact 01Q~SS2-45O9ext 6366 b. For invoice questions (payrmembe) contact 919-662-45OQextS245 C. NCSBU fax numbers are 918-B62~430OorB19~5O1-5977. 17. NC88| mailing address is-, State Bureau of Investigation, Criminal |mfomnadnm and Identification Section, Aftem§om Applicant Unit, P{} Box 29500, Raleigh, NC 27825� 18, Please ensure all contact personnel sign a copy of this form and include itim the packet mailed hothe WOS8(. Photocopies of this form may bm made amneeded. ~~This fon-nmhould be signed hy all personnel who will receive4iew the CHR1 (Recommend no more than three for security purposes.) This form may be photocopied, �~ Revised Oct 2008